Acute abdomen in a 54-year-old COVID-19 patient: a case report

Abstract

Although primarily a respiratory virus, coronavirus-19 acts on the gastrointestinal tract to cause symptoms such as anorexia, nausea, vomiting and diarrhea. One possible mechanism involves the ACE2 receptor, which serves as the primary receptor for virus entry into the gastrointestinal epithelium. We describe the case of a 54-year-old-male with recent coronavirus disease 2019 (COVID-19) infection, who later presented with nausea, vomiting, diarrhea and progressively worsening diffuse abdominal pain for 1 week. He was diagnosed to have a small bowel obstruction; however, continued to have progressively worsening pain and failed conservative management. No cause for the obstruction was found in the operating room. Gastrointestinal involvement occurs in at least two-thirds of patients with coronavirus infection. Viral entry into the small bowel, triggering an inflammatory response, and virus-induced microthrombosis of the microcirculation have been postulated as a possible mechanism for paralytic ileus/small bowel obstruction.

Bowel ischemia in COVID‐19: A systematic review

“…One of the suggested mechanisms for paralytic ileus/small bowel obstruction is through the inflammatory process from the virus entry into the small intestine and leading to micro thrombosis of the microcirculation 32 . Studies have shown that in patients infected with coronavirus gastrointestinal involvement is seen in at least two‐thirds of patients.…”

“…30 One of the suggested mechanisms for paralytic ileus/small bowel obstruction is through the inflammatory process from the virus entry into the small intestine and leading to micro thrombosis of the microcirculation. 32 Studies have shown that in patients infected with coronavirus gastrointestinal involvement is seen in at least twothirds of patients. Coagulation abnormalities and elevated D-dimer levels were noted in patients with COVID-19 and are related to a poor clinical outcome and a very high inpatient mortality rate.…”

Abdominal compartment syndrome caused by severe acute gastric distension in a patient with COVID-19: A case report

“…[1] Gastrointestinal (GI) manifestations are common extrapulmonary presentations of COVID-19, as the GI tract is involved in the early stages of the disease and is an important entry site for the viruses. [2][3][4] GI manifestations, which include abdominal pain, anorexia, nausea, vomiting, and diarrhea, may appear even earlier than respiratory symptoms. [4,5] Common entities include enterocolitis, ileus, and bowel ischemia due to thromboembolisms associated with coagulopathy.…”

“…[ 2 , 4 ] In addition, intestinal obstruction without a predisposing cause is rarely reported in patients with COVID-19. [ 3 , 6 ] Previous research has proposed that the angiotensin-converting enzyme 2 receptor mediates viral entry to the GI tract and microthrombosis formation. [ 4 ] Several potential theories regarding GI presentation during COVID-19 such as fecal to oral transmission or concept of the microbiota alteration have been reported.…”